Provider Demographics
NPI:1992761456
Name:LIWAG, CELERINA MARY JOYCE (MD)
Entity type:Individual
Prefix:DR
First Name:CELERINA
Middle Name:MARY JOYCE
Last Name:LIWAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CELERINA
Other - Middle Name:MARY JOYCE PUGEDA
Other - Last Name:LIWAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:159 NORTH READING RD
Mailing Address - Street 2:BACA PEDIATRICS
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1671
Mailing Address - Country:US
Mailing Address - Phone:717-733-0790
Mailing Address - Fax:717-733-1802
Practice Address - Street 1:159 NORTH READING RD
Practice Address - Street 2:BACA PEDIATRICS
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1671
Practice Address - Country:US
Practice Address - Phone:717-733-0790
Practice Address - Fax:717-733-1802
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417725208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018947580002Medicaid
50038237OtherCAPITAL BLUE CROSS